NIDAHAS CHINTHANA SANSADAYA
Consumer Action Forum - Mental Health
CONTACT DETAILS
Name of organisation Nidahas Chinthana Sansadaya – Consumer Action Forum (CAF)
Street address City Office: 99C, Ihala Yagoda
City Ganemulla
Country SRI LANKA
Post code 11020
Name of contact person Chintha J Munasinghe
Position Founder/National Organizer
Contact numbers Work +94 333150796 Mobile + 94 77 3608234
ORGANISATIONAL SUMMARY
A non-discriminating society promoting mental well-being and inclusion of
VISION persons with psychosocial disabilities
Building an inclusive non-stigmatized society where rights of persons with
MISSION psychosocial disabilities are respected
1) To ensure access of community mental health services at the localities of
OBJECTIVES mentally ill people
2) To help mentally ill people and their families to improve their quality of
life
3) To use experiences of mentally ill people and the information generated
through their work, to change the attitudes, practices and policies for
inclusion of mentally ill people and their families
The membership comprises Sri Lankans diagnosed for experiencing a
MEMBERSHIP mental illness. To be eligible for the membership, they should be
stabilized/ controlling the illness for at least 6-months under the supervision
of a mental health professional and willing to share their life experience
publicly to educate the general public, after training. Every member shall
complete a registration form and pay a membership fee of Rs.100/- to
become a member.
Honorary membership is offered to other community members and
professionals who are committed for the social inclusion of persons with
mental illnesses
1
CONTEXT
More than three decades of conflict and the effects of the Tsunami are having a strong impact on the
mental well-being of the Sri Lankan population, especially, on its most deprived sectors. Mental health
data from Sri Lanka shows an increase in severe and common mental disorders, in times of armed
conflict. The country has one of the highest suicide rates in the world. Further, misuse of alcohol is
frequent, especially in areas affected by disaster. It is estimated that 3% of the Sri Lankan population
suffer from some kind of mental illness. [WHO, 2008].
The Social Perceptions and level of understanding mental illnesses:
Sri Lankan consumers though represented in all strata of
economy, stigma is mostly observed in middle class and
upper middle-class families. Among the poorer strata of
the community especially living in the rural Sri Lanka, the
social acceptance of mentally ill people observed to be
high in comparison to those belong to the high society.
Even in the rural communities the person’s freedom of
movement at the time of illness in most instances gets
restricted, due to over protection as a measure to prevent
from meeting accidents, discrimination and social
rejection.
This is mainly due to the lack of awareness among the NICHOLAS
community about the mental illnesses and myths on “Hello.. Hello.. We found an estate
consumers, leading to unnecessary fear. On the other worker roaming in the village when
hand unawareness and stigma make many families hide people tried to inform the police. He
their member consumers, preventing them from taking is mentally ill. We searched and
treatment. found his family who are reluctant
to keep him due to his illness. For
two days, he was with us. As the
Consumers in Sri Lanka: village mental health clinic date was
Mental illnesses were not new to Sri Lanka, and for passed, would you inform Dr.
generations consumers of mental health were treated by Ranjani that we are bringing him to
traditional doctors, spiritual therapists as well as using Matara hospital day after
many other therapies such as Tovil (Drama Therapy), tomorrow? We will get him treated
and provide care. In the meantime,
music therapy. Religious places in the community has
Maryhamy is taking charge of his
been operating as counseling centres as well as providing family, educating them”
respite care facilities providing shelter and food to the (A telephone call to the Founder.
idling persons with chronic mental illnesses. Even today, Uncle Nicholas and his wife, Maryhamy
many relate to the cause of mental illnesses as a curse or who are elderly consumer advocates of
CAF. They do a lot of mobilisation and
acquiring the spirit of the dead, which has not been respite care service voluntarily in a
proved scientifically. remote village of Katuwana, 2018)
Research based on the analysis of life stories of the
members of Consumer Action Forum proved that about 60% of mental illnesses occurred after a death
of a close relative, which is basically a situation of trauma and 80% of them were found to be those
experiencing Depression. Interestingly, linking mental illness to a spirit of a dead has contributed to the
2
reduction of stigma. Yet, it made many people spending all their earning on traditional rituals and
practices to get rid of the spirit, without consulting a psychiatrist.
Mental Healthcare Services in Sri Lanka:
There were only 12 psychiatrists and 46 Medical Officers – Mental Health providing mental health
services at secondary healthcare level, in 2001. Community based mental healthcare was not
implemented at the time, when BasicNeeds Sri Lanka initiated its pilot project to develop the model –
“Mental Healthcare and Development with Community Partnership” [2001 - 2006]. Compared to the
year 2000, Sri Lanka has developed tremendously in the provision of mental health services through a
network of 82 psychiatrists and more than 100 medical officers – mental health, covering more than ¾
of the island (Figure 1). Presently, the country has a comprehensive National Mental Health Policy and
the Legislation, which prioritized the need for incorporating mental health services into the stream of
public health system with the financial assistance through World Bank Health Sector Development
Project [2005-2010], complemented by the community-based interventions of local and international
NGOs operating in the country. As an outcome of those efforts, developments have observed in the
media and health sectors, where more and more awareness and stigma reduction programmes are
observed towards gaining due respect in the case of persons with mental illnesses in the society.
Despite all these efforts, there still exists the treatment gap and the key issues observed are:
i) Reluctance of approaching mental health services by the consumers due to family influence,
lack of confidence, and stigma;
ii) Non-availability of community support structures that provide community care and advocate
for the rights of mentally ill people and support the mental health professionals in the effective
delivery of their services in the localities.
iii) Frequent shortages of psychotropic drugs available in the peripheral hospitals
iv) Lack of outreach therapeutic and follow-up programmes focusing on social- and economic re-
integration of stabilized consumers in mental health.
Jayantha gunasekera, CAF office bearer sharing experience with government offic ials
Figure 1: Distribution of Mental Health Services in Sri Lanka
3
MULTI-SECTORAL APPROACH
The answers to above mentioned issues are available with none other than stabilized consumers
themselves. It is their responsibility to address those two issues, towards prevention of incidents of
violation of the rights of mentally ill people and reduction of stigma. It should be their duty to
collaborate with, and support service providers to extend mental health services to the most
vulnerable families of mentally ill people.
Table 1: Role of Consumers and other stakeholders
Mental Other Stabilized Community
Health service Consumers Leaders
service providers
providers
Awareness creation & mobilization
Treatment
Therapeutic assistance
Rehabilitation & skill development
Social & livelihood development support
Policy influence and education
4
ROLE OF STABILIZED CONSUMERS – NIDAHAS CHINTHANA SANSADAYA
Nidahas Chinthana Sansadaya popularly known as Consumer
Action Forum (CAF) was established in late 2005 with 12
stabilized consumers under the leadership of Chintha J.
Munasinghe during BasicNeeds Sri Lanka’s Community
Mental Health and Development Programme. It was to ensure
that persons with mental illnesses taking the lead in bringing
out their peers, and families from southern Sri Lanka to
acquire services and participate in community-level
programmes (Table 1).
She started this mobilization process in 2002, as the first
professional in Sri Lanka who revealed her status through her
life story at BasicNeeds Sri Lanka’s community consultation
workshops in remote villages of southern Sri Lanka. Today,
following her, there are many advocates preaching in
different villages and stakeholder forums not limiting to
southern Sri Lanka, helping the isolated persons with mental
illnesses to come out while sensitizing the society, so that
their rights are not violated.
Role of Stabilized Consumers:
Nidahas Chinthana Sansadaya – Consumer Action Forum
(CAF), is formed of 154 stabilized mentally ill persons, who
participated actively in all the activities of the DFID-UK funded
BasicNeeds Pilot Project: Mental Health and Development
through Community Partnership [2003-2007] designed by a
stabilized consumer 1, as the former Country Programme
Manager of BasicNeeds Sri Lanka2 [2001-2006] who facilitated
those stabilised consumers to organize themselves. While
consumers are the members with voting rights, CAF also has
peripheral committees consists of community volunteers,
mental health/health practitioners and the committed
officers of BasicNeeds and its partners, who have supported
them under this project (Figure 2).
Today the CAF membership includes entrepreneurs,
employees of private and other sectors, students, community
leaders, trainers/resource persons, dramatists, writers,
barefoot researchers, and productive family members. They
are committed to the organisational mission and practice what they preach. The life experience and
skills of the members of CAF who are presently playing a leading role as consumer activists/advocates
proving themselves as socially recognized and productive citizens of the country, are taking the lead in
1 Chintha Munasinghe
2 www.basicneeds.org.uk
5
the planning, implementing, and reviewing CAF performance for which they are accountable to the
membership and the regulatory authorities.
Figure 2: The operational structure of CAF
Advisory Committee President
Office Bearers Membership
Finance Assistant Coordinator
Thematic areas
Community Mobilization Mental Wellbeing Promotion
Livelihood Development Rights Promotion & Advocacy
Interventions
Micro-credit revolving fund User-led research
Emotional Support and Referrals Human Library & Forum Theatre
The Operational Structure:
CAF’s main team of operations comprising the office bearers committee which include consumer
advocates holding the key positions including the President, Secretary and Treasurer. Presently the
committee has a membership of 11 members including active community animators as selected by the
consumer members in each divisional secretariat division. Founder being the great supporter of the
organization in many ways, considered by the members as the visionary and the supervisor of the
actions they plan and perform.
There is an advisory committee consists of professionals in the sectors of mental health,
communications, research and economic development. Among them are also consumers with
commitment to support CAF efforts, though they are not ready to reveal their status or share their
personal experiences. Coordinator position is filled by a consumer/community animator recognized by
the membership. There are four team leaders (3 consumers and 1 community volunteer) responsible
for four sections: i) Community Mobilization; ii) Mental Well-being Promotion; iii) Livelihood
Development, and iv) Rights Promotion & Advocacy.
When the programmes are organized the members tend to attend to the community needs on
voluntary basis. CAF operates on its own as well as through partnerships that either provides financial
or non-financial assistance and the key partners are as below:
6
• Laymen’s Den (Pvt) Ltd. – Strategic Management Assistance (2009 to date); Development of the CAF
Theatre Group, Theatre of the Oppressed (2008 – 2010); Promotional and Advocacy material
Development (2008 to date)
• BasicNeeds Sri Lanka – A’pelessa Eleders Day Care Centre
(October 2009 – June 2010); Community Mental Health and Livelihood Development Programme
(2010 to date)
• VSO Sri Lanka – Publishing the Life Story of Sriyani Dhammika, Former President of CAF (2009)
• Business Creations – Wellodaya Village Development Action
(January 2010 – December 2010)
• Community Business and Technology Developers (CBTD) – Case study development & Disability
Rights education (2010)
• SEEDS (Guarantee) Ltd. – Inclusive Business Development Services Model development (2010 –
2011)
• MyRights – Advocacy to rights & Empowerment (2011 – 2014)
• Navajeevana Rehabilitation – Tangalla – Swabhimani Micro-credit Revolving Fund (2019)
The present focus areas of CAF are as below:
• Educating community on effects and issues related to mental ill health for reducing stigma and
discrimination. The Theatre group comprising 12 consumer advocates trained by the founder, who
is a trainer on Forum Theatre, use their life-stories based drama to sensitize the community on
social stigma, causes and impacts of mental illnesses on the person affected, and their families
using forum theatre approach. They perform at villages, workshops and special events organized
by other development agencies as well as at media forums. They also use village planning meetings
to raise the need for including mentally ill people and other marginalized groups, in community
development activities in the area. Every possible instance during a day (at the bus stand,
restaurant, official meeting), they use for educating the society on these aspects in a most
diplomatic/friendly way. “Theater of the Oppressed” also perform in higher level events on
request, e.g. World Health Day 2017 organized by WHO; World Mental Health Day 2017 organized by
NIMH.
• Building confidence of community development workers to involve mentally ill people and their
families in development programmes. About 60% of the members of CAF are engaged in income
7
generation activities, while controlling their illness and its effects. This itself has demonstrated
their ability to perform as productive human beings in the society. All of them are not considered by
the families as a burden, and therefore sharing their life experiences with development workers
and facilitators have contributed to changing the attitudes of such officers. For instance, by
participating at a Trade Fair in 2012, organised by SEEDS (Gte) Ltd. CAF members were able to clear
myths and build confidence of about 10 business development officers and 20 small entrepreneurs,
who participated at the event. The CAF stall was awarded the 3rd place of the “Best Stall
Competition” among the 60 participants, which was judged by an independent panel of
professionals, based on the criteria: sales amount; quality of products; stall display; customer
relations, etc.
• Encouraging mental health
professionals to develop
partnership with development
organisations. Though not done
in large scale, presently CAF with
CAN-MH is having discussions
with the professionals from WHO,
National Institute of Psychiatry
and SEEDS to see the potential
for developing an inclusive
development projects –
Community Mental Health Care
with Consumer Partnership and
Inclusion of persons with mental
illnesses in enterprise
development. CAF has linked Dr.
Neil Fernando, with Enterprise
Services Division of SEEDS to educate their team on mental health and different aspects of working
with persons with mental illnesses. CAF also represented at the Southern Province Forum for
Disability Inclusive Economic Development (SPFDIED), convened by Southern Province Social
Service Department with Navajeevana Rehabilitation – Tangalla. CAF Mental Well-being Promotion
team facilitate referrals to outreach mental health clinics and contribute voluntarily helping MOMH
on clinic days, referrals from community to the clinics; organizing home visits in the case of severely
ill persons. They also serves as livelihood animators with therapeutic support for them return to
their livelihood ventures – e.g. self-help group ventures (model farms; production work; group
marketing, etc,.)
• Advocating and providing support for effective implementation of the National Mental Health
Policy. The role here CAF plays is educating the mentally ill people on their rights and entitlements
at community level and sharing the learning at national and international level. CAF members
participated in the Public Consultations on Constitutional Reforms; Dialogues and sensitization
programmes on Convention for Rights of Persons with Disability (CRPD) for policy makers,
administrators, implementers and media, nationally and internationally.
8
Princy, a member of CAF sharing her life experience with government officials around the country
Chintha Munasinghe, Founder of CAF sharing CAF experience at TCI Asia conference in Japan
Through these activities CAF provides opportunity for its members controlling mental illnesses to: i)
Build partnership with other stakeholders to break the glass ceiling, by performing their duties to
exercise their rights; and ii) Develop themselves as effective mobilizers/animators and designers of
community interventions ensuring the inclusion of mentally ill people.
Recognizing their work in November 2009, CAF was awarded the third place on Productivity Award
given by the District Secretary of Hambantota. In 2017 Mental Health Day, our elderly members Mr.
Nikulas and Mrs. Maryhamy was awarded by the Hon. President of Sri Lanka, Mr. Maithreepala Sirisena
in appreciation of their community mental health work in the community.
9
Two CAF members who are consumer advocates, Mr. Nikulas and Mrs. Maryhamy received an Award from
Hon. President on World Mental Health Day, October 10, 2017
Table 2: Role of Nidahas Chinthana Sansadaya
Area Action Outcome
• Theatre of Oppressed – forum theatre
based on consumers’ life stories
• More mentally ill people
Community performed at village level & National
registered for mental
Mobilization and level
health services
reduction of • Sharing life stories and conduct at
• Community attitudes
stigma participatory consultation workshops
changed
• Organising exploration visits for health
and development practitioners
• Organising outreach clinics at village • Decrease in treatment
level gap
Assistance in • Referrals • Effective and efficient
mental health • Communicate issues that service mental health services at
service delivery providers are challenged with to the localities of mentally ill
decision makers people
• Increase of membership
Capacity • Self-help group mobilisation
• Continuity of medication
building – • Follow-up visits by CAF members
• Inclusion of stabilised
consumers and • Mental health educational programmes
consumers in livelihood
carers • Livelihood development programmes
programmes
User – led • Self-monitoring and observations by • Insight about oneself
research & other members • Learning shared
Information • Life story analysis • Policy influenced
10
Area Action Outcome
• Participating and organising advocacy • Institutional policies &
Advocacy forums practices changed
11
